• M L L Madariaga, J J Guthmiller, S Schrantz, M O Jansen, C Christensen, M Kumar, M Prochaska, G Wool, A Durkin-Celauro, W H Oh, L Trockman, J Vigneswaran, R Keskey, D G Shaw, H Dugan, N-Y Zheng, M Cobb, H Utset, J Wang, O Stovicek, C Bethel, S Matushek, M Giurcanu, K G Beavis, D di Sabato, D Meltzer, M K Ferguson, J P Kress, K Shanmugarajah, J B Matthews, J F Fung, P C Wilson, J C Alverdy, and J S Donington.
• From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA.
• J. Intern. Med. 2021 Apr 1; 289 (4): 559573559-573.

BackgroundConvalescent plasma therapy for COVID-19 relies on transfer of anti-viral antibody from donors to recipients via plasma transfusion. The relationship between clinical characteristics and antibody response to COVID-19 is not well defined. We investigated predictors of convalescent antibody production and quantified recipient antibody response in a convalescent plasma therapy clinical trial.MethodsMultivariable analysis of clinical and serological parameters in 103 confirmed COVID-19 convalescent plasma donors 28 days or more following symptom resolution was performed. Mixed-effects regression models with piecewise linear trends were used to characterize serial antibody responses in 10 convalescent plasma recipients with severe COVID-19.ResultsDonor antibody titres ranged from 0 to 1 : 3892 (anti-receptor binding domain (RBD)) and 0 to 1 : 3289 (anti-spike). Higher anti-RBD and anti-spike titres were associated with increased age, hospitalization for COVID-19, fever and absence of myalgia (all P < 0.05). Fatigue was significantly associated with anti-RBD (P = 0.03). In pairwise comparison amongst ABO blood types, AB donors had higher anti-RBD and anti-spike than O donors (P < 0.05). No toxicity was associated with plasma transfusion. Non-ECMO recipient anti-RBD antibody titre increased on average 31% per day during the first three days post-transfusion (P = 0.01) and anti-spike antibody titre by 40.3% (P = 0.02).ConclusionAdvanced age, fever, absence of myalgia, fatigue, blood type and hospitalization were associated with higher convalescent antibody titre to COVID-19. Despite variability in donor titre, 80% of convalescent plasma recipients showed significant increase in antibody levels post-transfusion. A more complete understanding of the dose-response effect of plasma transfusion amongst COVID-19-infected patients is needed.© 2020 The Association for the Publication of the Journal of Internal Medicine.

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